NR 470 Exam 3

Vitamin A supplementation may be recommended for the young child who has which disease? a. Mumps b. Rubella c. Measles (rubeola) d. Erythema infectiosum

c. Measles (rubeola)

A nurse is initiating seizure precautions for a child being admitted to the nursing unit. Which of the following items should the nurse place at the bedside?

A suction apparatus and oxygen

The nurse is caring for a 16-year-old female who remains unconscious 24 hours after sustaining a closed-head injury in an MVA. She responds to deep painful stimulation with decorticate posturing. The child has an intracranial monitor that shows periodic increased ICP. All other vital signs remain stable.

Attempt to keep the environment dark and quiet, and encourage minimal stimulation. Rational: A dark, quiet environment and minimal stimulation will decrease oxygen con sumption and ICP.

The nurse is giving instructions to parents of a school-age child diagnosed with sickle cell disease. The instructions should include which of the following?

Avoid areas of low oxygen concentration such as high altitudes.

The parent of a 4-year-old brings the child to the clinic and tells the nurse the child's abdomen is distended. After a complete examination, a diagnosis of Wilms tumor is suspected. Which of the following is most important when doing a physical examination on this child?

Avoid palpation of the abdomen.

The nurse is caring for a child who has been in an MVA. The child continues to fall asleep unless her name is called or she is gently shaken. The nurse knows that this state of consciousness is referred to as:

Obtunded - a state of consciousness in which the child has a limited response to the environment and can be aroused by verbal or tactile stimulation.

what gender is more associated with LCP disease?

male

The parents of a child with cystic fibrosis ask the nurse why their child must receive supplemental pancreatic enzymes. Which response by the nurse would be most appropriate?

"Pancreatic enzymes promote absorption of nutrients and fat."

A mother brings her 15-month-old child to the health care provider's office with complaints that the child has suddenly developed a bright red rash on her cheeks. She has no other symptoms and has been playing and eating as usual. Based on the appearance of the child, the nurse might suspect that the child has:

Fifth disease Rationale: Fifth disease has the general appearance of "slapped cheeks." Many children do not have any symptoms prior to the appearance of the reddened cheeks

A child seen in the clinic is found to have rubeola (measles), and the mother asks the nurse how to care for the child. The nurse tells the mother that she should:

Keep the child in a room with dim lights. Rationale: A nursing consideration in rubeola is eye care. The child usually has photophobia, so the nurse should suggest that the parent keep the child out of brightly lit areas.

"A preschool client immobilized in a spica cast complains of having trouble breathing after meals. What actions would be best? "

Offer the client small feedings several times a day. RATIONALE: A hip spica cast extends up over the abdomen. Because the abdomen is in a fixed space, abdominal distention secondary to eating pushes the abdominal contents against the diaphragm resulting in decreased chest expansion and subsequent possible respiratory distress.

A nurse is assisting with data collection from an infant who has been diagnosed with hydrocephalus. If the infant's level of consciousness diminishes, a priority intervention is:

Palpating the anterior fontanel

A nurse is assessing a child and notes Koplik spots. In which of these communicable diseases are Koplik spots present? a. Rubella b. Measles (rubeola) c. Chickenpox (varicella) d. Exanthema subitum (roseola)

b. Measles (rubeola)

2. Airborne isolation is required for a child who is hospitalized with: a. mumps. b. chickenpox. c. exanthema subitum (roseola). d. erythema infectiosum (fifth disease).

b. chickenpox.

What is Aplastic Anemia?

Inability of the bone marrow to produce enough or ANY new cells. Low count in ALL three blood cell types.

What lab will be abnormal in a child with the diagnosis of hemophilia?

The partial thromboplastin time.

The nurse is developing a plan of care for a child recently diagnosed with CP. What should be the nurse's priority goal?

The priority for all children is to develop to their full potential.

what gender is more frequently affected by SCFE?

males

what are the 2 tests to check for DDH?

ortolani and barlow

what is the treatment for DDH?

pavlik harness for 6 months

what are the 4 types of club foot?

positional, teratologic, syndromic, congenital

this is a progressive slip of the femoral head over the femoral neck

slipped capital femoral epiphysis

these types of club feet almost always require surgery as definitive treatment

teratologic and syndromic

The nurse is teaching the parents of a 1-month-old infant with developmental dysplasia of the hip about preventing skin breakdown under the Pavlik harness. Which of the following statement by the parent would indicate a correct understanding of the teaching?

"I should gently massage the skin under the straps once a day to stimulate circulation."

What are the 3 C's for Measles (Rubeola)?

- Coryza - Cough - Conjunctivitis

What are the nursing interventions associated with Measles (Rubeola)?

- Isolation - Supportive management for fever and discomfort - Dimly lit room or sunglasses for photophobia - Fluids

What are the nursing interventions for the patient with German Measles (Rubella)

- Isolation with droplet and airborne precautions - Isolation from pregnant women due to teratogenic effects on fetus

Complications of Roseola (exanthem Subitum)?

- Recurrent febrile seizures - Mononucleosis like illness - Encephalitis (rare)

What is the drug of choice for treating mild pain in children?

Acetaminophen

What measures should the nurse teach the parent of a child with hemophilia to do first if the child sustains an injury to a joint causing bleeding?

Administer factor per the home care protocol.

What analgesics is most effective for a child with sickle cell pain crisis?

Morphine.

The nurse assesses the child frequently for which early sign of increased ICP?

Nausea

Which of the following will help a school-aged child with muscular dystrophy stay active longer? 1. Normal activities, such as swimming. 2. Using a treadmill every day. 3. Several periods of rest every day. 4. Using a wheelchair on getting tired.

1. Children who are active are usually able to postpone use of the wheelchair longer. It is important to keep using muscles for as long as possible, and aerobic activity is good for a child.

A nurse is receiving an infant with myelomeningocele from an outside hospital. Which of the following priority items should be placed at the newborn's bedside? 1. A bottle of normal saline. 2. A rectal thermometer. 3. Extra blankets. 4. A blood pressure cuff.

1. Before the surgical closure of the sac, the infant is at risk for infection. A sterile dressing is placed over the sac to keep it moist and help prevent it from tearing.

A nurse is caring for a child with von Willebrand disease. The nurse is aware that which of the following is a (are) clinical manifestation(s) of von Willebrand disease? Select all that apply. 1. Bleeding of the mucous membranes. 2. The child bruises easily. 3. Excessive menstruation. 4. The child has frequent nosebleeds. 5. Elevated creatinine levels. 6. The child has a factor IX deficiency.

1. Bleeding of the mucous membranes. 2. The child bruises easily. 3. Excessive menstruation. 4. The child has frequent nosebleeds.

A child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions should the nurse provide to prevent another crisis from occurring? Select all that apply. 1. Drink plenty of fluids. 2. Avoid foods high in folic acid. 3. Use cold packs to relieve joint pain. 4. Restrict all activity to quiet board games. 5. Wash hands before meals and after playing. 6. Report a sore throat immediately.

1. Drink plenty of fluids. 5. Wash hands before meals and after playing. 6. Report a sore throat immediately. Rationale: Sickle cell crisis can be precipitated by cold, dehydration, stress, or infection. Increasing the amount of fluids will reduce the viscosity of blood, thus preventing vascular occlusion. A conscious effort to wash hands can improve the child's health by preventing infection. A sore throat is a sign of an infection and must be reported. It is important to avoid cold temperatures of any kind because this can cause vaso-occlusion.

A mother of a 3-year-old child tells the nurse that the child has been continuously scratching the skin and has developed a rash. On data collection, which finding indicates that the child may have scabies? 1. Fine, grayish-red lines 2. Purple-colored lesions 3. Thick, honey-colored crusts 4. Clusters of fluid-filled vesicles

1. Fine, grayish-red lines

The mother of a child with Duchenne muscular dystrophy asks the nurse who in the family should have genetic screening. Who should the nurse say must be tested? Select all that apply. 1. The mother and father. 2. The sister. 3. The brother. 4. The aunts and all female cousins. 5. The uncles and all male cousins.

1. Genetic counseling is important in all inherited diseases. Duchenne muscular dystrophy is inherited as an X-linked recessive trait, meaning the defect is on the X chromosome. Women carry the disease, and males are affected. All female relatives should be tested. 2. Women carry the disease, and males are affected. All female relatives should be tested. 4. Women carry the disease, and males are affected. All female relatives should be tested

The parent of a toddler newly diagnosed with CP asks the nurse what caused it. The nurse should answer which of the following? 1. Most cases are caused by unknown prenatal factors. 2. It is commonly caused by perinatal factors. 3. The exact cause is not known. 4. The exact cause is known in every instance.

1. Most cases are caused by unknown prenatal factors.

A 5-year-old has been diagnosed with pseudohypertrophic muscular dystrophy. Which of the following nursing interventions would be appropriate? 1. Discuss with the parents the potential need for respiratory support. 2. Explain that this disease is easily treated with medication. 3. Suggest exercises that will limit the use of muscles and prevent fatigue. 4. Assist the parents in finding a nursing facility for future care

1. Muscles become weaker, including those needed for respiration, and a decision will need to be made about whether respiratory

The parents of a preschooler diagnosed with muscular dystrophy are asking questions about the course of their child's disease. The nurse should tell them which of the following? 1. Muscular dystrophies are disorders associated with progressive degeneration of muscles, resulting in relentless and increasing weakness. 2. The weakness that the child is currently experiencing will probably not increase. 3. The child will be able to function normally and require no special accommodations. 4. The extent of degeneration depends on performing daily physical therapy

1. Muscular dystrophies are progressive degenerative disorders. The most common is Duchenne muscular dystrophy, which is an X-linked recessive disorder.

A child is admitted to the hospital with sickle cell crisis. The nurse checks this child for which frequent symptom of the disorder? 1. Pain 2. Diarrhea 3. Bradycardia 4. Blurred vision

1. Pain Rationale: Sickling crisis often causes pain in the bones and joints, accompanied by joint swelling. Pain is a classic symptom of the disease and may require large doses of opioid analgesics when it is severe.

A child is diagnosed with scarlet fever. A nurse collects data regarding the child. Which of the following is a clinical manifestation of scarlet fever? 1. Pastia's sign 2. Abdominal pain and flaccid paralysis 3. Dense pseudoformation membrane in the throat

1. Pastia's sign Rationale: Pastia's sign is a rash seen among children with scarlet fever that will blanch with pressure, except in areas of deep creases and in the folds of joints. The tongue is initially coated with a white furry covering with red projecting papillae (white strawberry tongue). By the fourth to fifth day, the white strawberry tongue sloughs off and leaves a red, swollen tongue (strawberry tongue). The pharynx is edematous and beefy red in color.

A 4-year-old child with acute lymphocytic leukemia has been admitted to the hospital in relapse. The priority concern is infection due to immunosuppression. Which of the following interventions would the nurse include in the plan of care? 1. Perform oral hygiene four times a day. 2. Monitor vital signs once a shift. 3. Inspect the child's mouth daily for mouth ulcers.

1. Perform oral hygiene four times a day. Rationale: The child who is immunosuppressed is at risk for infection, and interventions must be performed frequently to prevent infection.

A nurse is caring for a hospitalized child with a diagnosis of rubella (German measles). The nurse reviews the health care provider's progress notes and reads that the child has developed Forchheimer sign. Based on this documentation, which of the following should the nurse expect to note in the child?

1. Petechiae spots located on the palate Rationale: Forchheimer sign refers to petechiae spots, which are reddish and pinpoint and located on the soft palate

The parent of a 6-year-old with a repaired myelomeningocele is in the clinic for her child's regular examination. The child has frequent constipation and has been crying at night because of pain in the legs. After an MRI, the diagnosis of a tethered cord is made. Which of the following should the nurse tell the parent? 1. Tethered cord is a postsurgical complication. 2. Tethered cord occurs during times of slow growth. 3. Release of the tethered cord will be necessary only once. 4. Offering laxatives and acetaminophen daily will help control these problems.

1. Tethered cord is caused by scar tissue formation from the surgical repair of the myelomeningocele and may affect bowel, bladder, or lower extremity functioning

Which of the following activities should a nurse suggest for a client diagnosed with hemophilia? Select all that apply. 1. Swimming. 2. Golf. 3. Hiking. 4. Fishing. 5. Soccer.

1. Swimming. 2. Golf. 3. Hiking. 4. Fishing.

Which of the following factors need(s) to be included in a teaching plan for a child with sickle cell anemia? Select all that apply. 1. The child needs to be taken to a physician when sick. 2. The parent should make sure the child sleeps in an air-conditioned room. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

1. The child needs to be taken to a physician when sick. 3. Emotional stress should be avoided. 4. It is important to keep the child well hydrated. 5. It is important to make sure the child gets adequate nutrition.

A child with hemophilia A fell and injured a knee while playing outside. The knee is swollen and painful. Which of the following measures should be taken to stop the bleeding? Select all that apply. 1. The extremity should be immobilized. 2. The extremity should be elevated. 3. Warm moist compresses should be applied to decrease pain. 4. Passive range-of-motion exercises should be administered to the extremity. 5. Factor VIII should be administered.

1. The extremity should be immobilized. 2. The extremity should be elevated. 5. Factor VIII should be administered.

A nurse is collecting data about a child who has been admitted to the hospital with a diagnosis of seizures. The nurse checks for causes of the seizure activity by:

Obtaining a history regarding factors that may occur before the seizure activity

What is the infectious agent that causes measles (rubeola)?

Paramyxovirus

"Immediately after the return of an 18-month-old child to his room following insertion of a ventriculoperitoneal shunt, which of the following would the nurse do first?"

Position him on the side opposite the shunt site. RATIONALE: As soon as the child returns to his room, he needs to be positioned appropriately, in this case on the side opposite the shunt placement to avoid pressure on the operative site.

The nurse is caring for a neonate born with a myelomeningocele. Surgery to repair the defect is scheduled the next day. The most appropriate way to position and feed this neonate is to place him:

Prone

What are the s/s of the acute stage of Measles (Rubeola)?

Rash appears for 3-4 days later. Reddened, maculopapular rash begins on face and spread downward.

A nurse is developing a plan of care for a child who is at risk for seizures. Which interventions apply if the child has a seizure? Select all that apply. 1. Time the seizure. 2. Restrain the child. 3. Stay with the child. 4. Place the child in a prone position. 5. Move furniture away from the child. 6. Insert a padded tongue blade into the child's mouth.

1. Time the seizure.. 3. Stay with the child. 5. Move furniture away from the child.

what age group is associated with SCFE?

10-15 y/o

Which statement indicates that the female client with systemic lupus erythematosus (SLE) understands the discharge instructions? 1. "I should wear sunscreen with at least a 5 SPF." 2. "I am not going to any activities with large crowds." 3. "I should not get pregnant because I have SLE." 4. "I must avoid using hypoallergenic products."

2. "I am not going to any activities with large crowds."

What is the most common hematologic disorder in infancy?

Anemia

The nurse is caring for an infant with myelomeningocele who is going to surgery later today for closure of the sac. Which of the following would be a priority nursing diagnosis before surgery? 1. Alteration in parent-infant bonding. 2. Altered growth and development. 3. Risk of infection. 4. Risk for weight loss.

3. A normal saline dressing is placed over the sac to prevent tearing, which would allow the cerebrospinal fluid to escape and microorganisms to enter and cause an infection.

what age group is associated with LCP disease?

4-10 y/o

The nurse is caring for a school-aged child with Duchenne muscular dystrophy in the elementary school. Which of the following would be an appropriate nursing diagnosis? 1. Anticipatory grieving. 2. Anxiety reduction. 3. Increased pain. 4. Activity intolerance.

4. The child would not be able to keep up with peers because of weakness, progressive loss of muscle fibers, and loss of muscle strength.

Which of the following should the nurse expect as an intervention in a child in the recovery phase of GBS? 1. Assess for respiratory compromise. 2. Assess for swallowing difficulties. 3. Evaluate neuropsychological functioning. 4. Begin an active physical therapy program

4. Beginning active physical therapy is important for helping muscle recovery and preventing contractures.

The Gower sign for assessing Duchenne muscular dystrophy can be elicited by having a patient do which of the following? 1. Close the eyes and touch the nose with alternating index fingers. 2. Hop on one foot and then the other. 3. Bend from the waist to touch the toes. 4. Walk like a duck and rise from a squatting position.

4. Children with muscular dystrophy display the Gower sign, which is great difficulty rising and standing from a squatting position due to the lack of muscle strength.

What is the acute stage of German Measles (Rubella)

Rash that starts in the face and rapidly spreads downward. Discrete pinkish red maculopapular rash. Petechia - pinpoint spots that appear on the soft palate.

A nurse is assisting a health care provider (HCP) during the examination of an infant with hip dysplasia. The HCP performs the Ortolani maneuver. Which of the following best describes the action/purpose of the Ortolani maneuver?

Reducing the dislocated femoral head back into the acetabulum

A mother of a child brings the child to a clinic and reports that the child has a fever and has developed a rash on the neck and trunk. Roseola is diagnosed, and the mother is concerned that her other children will contract the disease. Which instruction should the nurse give to the mother to prevent the transmission of the disease?

1. "Disease transmission is unknown."

Which of the following should the nurse do first when caring for an infant who just had a repair of a myelomeningocele? 1. Weigh diapers for 24-hour urine output. 2. Measure head circumference. 3. Offer clear fluids. 4. Assess for infection

2. Hydrocephalus occurs in about 90% of infants with myelomeningocele, so measuring the head circumference daily and watching for an increase are important. Accumulation of cerebrospinal fluid can occur after closure of the sac.

A nursing instructor asks a student nurse to describe osteogenic sarcoma. Which statement by the student indicates the need to further research the disease? 1. "The femur is the most common site of this sarcoma." 2. "The child does not experience pain at the primary tumor site." 3. "If a weight-bearing limb is affected, then limping is a clinical manifestation."

2. "The child does not experience pain at the primary tumor site." Rationale: Osteogenic sarcoma is the most common bone tumor in children. A clinical manifestation of osteogenic sarcoma is progressive, insidious, intermittent pain at the tumor site.

A child is to be admitted to the orthopedic unit following a Harrington rod insertion for the treatment of scoliosis. The nurse is assisting in preparing a plan of care for the child. The nurse plans to monitor which priority item in the immediate postoperative period?

2. Capillary refill, sensation, and motion in all extremities Rationale: When the spinal column is manipulated during surgery, altered neurovascular status is a possible complication; therefore neurovascular assessments including circulation, sensation, and motion should be done every 2 hours.

The nurse is teaching family members of a child newly diagnosed with muscular dystrophy about early signs. The nurse knows that teaching was successful when a parent states that which of the following signs may indicate the condition early? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity.

2. Difficulty climbing stairs, running, and riding a bicycle are frequently the first symptoms of Duchenne muscular dystrophy

Which of the following describe(s) ITP? Select all that apply. 1. ITP is a congenital hematological disorder. 2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 4. Platelets are small in ITP. 5. Purpura is observed in ITP

2. ITP causes excessive destruction of platelets. 3. Children with ITP have normal bone marrow. 5. Purpura is observed in ITP

Which of the following should the nurse do first when a neonate with myelomeningocele experiences urine retention with overflow incontinence? 1. Apply pressure to the suprapubic area. 2. Initiate an intermittent clean catheterization program. 3. Insert an indwelling urinary catheter. 4. Collect a urine specimen.

2. Initiate an intermittent clean catheterization program.

Which of the following are characteristics of scabies? Select all that apply. 1. It is caused by a fungal infection. 2. It appears as burrows or fine, grayish-red lines. 3. It is transmitted by close personal contact with an infected person. 4. It is endemic among schoolchildren and institutionalized populations. 5. Meticulous skin care and the application of antifungal cream are components of treatment. 6. Household members and contacts of the infected child need to be treated at the same time that the child is being treated.

2. It appears as burrows or fine, grayish-red lines. 3. It is transmitted by close personal contact with an infected person. 4. It is endemic among schoolchildren and institutionalized populations. 6. Household members and contacts of the infected child need to be treated at the same time that the child is being treated.

A nurse assigned to care for a child with mumps is monitoring the child for the signs and symptoms associated with the common complication of mumps. The nurse monitors for which of the following that is indicative of this common complication?

2. Nuchal rigidity Rationale: The most common complication of mumps is aseptic meningitis, with the virus being identified in the cerebrospinal fluid. Common signs include nuchal rigidity, lethargy, and vomiting. A red, swollen testicle may be indicative of orchitis.

A newborn is diagnosed with a myelomeningocele at L2. Which of the following should be the priority nursing diagnosis for this infant at 12 hours of age? 1. Altered bowel elimination related to neurological deficits. 2. Potential for infection related to the physical defect. 3. Altered nutrition related to neurological deficit. 4. Disturbance in self-concept related to physical disability.

2. Potential for infection related to the physical defect.

The mother of a child with juvenile idiopathic arthritis calls the nurse because the child is experiencing a painful exacerbation of the disease. The mother asks the nurse if the child should perform range-of-motion (ROM) exercises at this time. The nurse makes which response to the mother? 1. "Avoid all exercise during painful periods." 2. "The ROM exercises must be performed every day." 3. "Have the child perform simple isometric exercises during this time." 4. "Administer additional pain medication before performing the ROM exercises."

3. "Have the child perform simple isometric exercises during this time."

A nurse provides information to the mother of a 2-week-old infant who was diagnosed with clubfoot at the time of birth. Which statement by the mother indicates the need for further instruction regarding this disorder? 1. "Treatment needs to be started as soon as possible." 2. "I realize my child will require follow-up care until full grown." 3. "I need to bring my child back to the clinic in 1 month for a new cast." 4. "I need to come to the clinic every week with my child for the casting."

3. "I need to bring my child back to the clinic in 1 month for a new cast." Rationale: The treatment for clubfoot is started as soon as possible after birth. Serial manipulation and casting are performed at least weekly. If sufficient correction is not achieved within 3 to 6 months, surgery is usually indicated.

A nurse assists with providing an instructional session to parents regarding impetigo. Which statement by a parent indicates the need for further instruction? 1. "It is extremely contagious." 2. "It is most common during humid weather." 3. "Lesions are most often located on the arms and chest."

3. "Lesions are most often located on the arms and chest." Rationale: Impetigo is most common during the hot and humid summer months. It begins in an area of broken skin, such as an insect bite. It may be caused by Staphylococcus aureus, group A β-hemolytic streptococci, or a combination of these bacteria. It is extremely contagious. Lesions are most often located around the mouth and nose, but they may be present on the extremities.

The nurse is taking care of a child with sickle cell disease. The nurse is aware that which of the following problems is (are) associated with sickle cell disease? Select all that apply. 1. Polycythemia. 2. Hemarthrosis. 3. Aplastic crisis. 4. Thrombocytopenia. 5. Splenic sequestration. 6. Vaso-occlusive crisis.

3. Aplastic crisis. 5. Splenic sequestration. 6. Vaso-occlusive crisis.

A nurse provides instructions to the mother of a child with impetigo regarding the application of antibiotic ointment. The mother asks the nurse when the child can return to school. Which response by the nurse is accurate? 1. Ten days after using the antibiotic ointment 2. One week after using the antibiotic ointment 3. Forty-eight hours after using the antibiotic ointment

3. Forty-eight hours after using the antibiotic ointment Rationale: The child should not attend school for 24 to 48 hours after the initiation of systemic antibiotics or for 48 hours after the use of the antibiotic ointment.

The nurse is discussing autoimmune diseases with a class of nursing students. Which signs and symptoms are shared by rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)? 1. Nodules in the subcutaneous layer and bone deformity. 2. Renal involvement and pleural effusions. 3. Joint stiffness and pain. 4. Raynaud's phenomenon and skin rash

3. Joint stiffness and pain.

Which of the following represents a primary characteristic of autism? 1. Normal social play 2. Consistent imitation of others' actions 3. Lack of social interaction and awareness 4. Normal verbal and nonverbal communication

3. Lack of social interaction and awareness Rationale: Autism is a severe form of an autism spectrum disorder. A primary characteristic is a lack of social interaction and awareness. Social behaviors in autism include a lack of or an abnormal imitation of others' actions and a lack of or abnormal social play.

A nurse is assigned to care for a child after a spinal fusion for the treatment of scoliosis. The child complains of abdominal discomfort and begins to have episodes of vomiting. On data collection, the nurse notes abdominal distention. Which action should the nurse take? 1. Administer an antiemetic. 2. Increase the intravenous fluids. 3. Notify the registered nurse (RN). 4. Place the child in a side-lying Sims' position.

3. Notify the registered nurse (RN). Rationale: A complication after the surgical treatment of scoliosis is superior mesenteric artery syndrome. This disorder is caused by mechanical changes in the position of the child's abdominal contents that result from the lengthening of the child's body. It results in a syndrome of emesis and abdominal distention that is similar to that which occurs with intestinal obstruction or paralytic ileus. Postoperative vomiting among children with body casts or among those who have undergone spinal fusion warrants attention because of the possibility of superior mesenteric artery syndrome.

A nurse is assigned to care for a child who is in skeletal traction. The nurse avoids which of the following when caring for the child? 1. Keeping the weights hanging freely 2. Ensuring that the ropes are in the pulleys 3. Placing the bed linens on the traction ropes 4. Ensuring that the weights are out of the child's reach

3. Placing the bed linens on the traction ropes Rationale: Bed linens should not be placed on the traction ropes because of the risk of disrupting the traction apparatus.

A nurse reinforces home-care instructions to the parents of a 3-year-old child who has been hospitalized with hemophilia. Which statement by a parent indicates the need for further instructions? 1. "I will supervise my child closely." 2. "I will pad the corners of the furniture." 3. "I will remove household items that can easily fall over." 4. "I will avoid immunizations and dental hygiene treatments for my child."

4. "I will avoid immunizations and dental hygiene treatments for my child." Rationale: The nurse needs to stress the importance of immunizations, dental hygiene, and routine well-child care.

A child with a fractured femur is placed in Buck's skin traction and the nurse is planning care for the client. Which information about this type of traction is correct? 1. Requires frequent pin care 2. Places the child at risk for infection 3. Uses skeletal traction and weights to provide a counterforce 4. Is a type of skin traction that pulls the hip and leg into extension

4. Is a type of skin traction that pulls the hip and leg into extension Rationale: Buck's skin traction is a type of skin traction used in fractures of the femur and in hip and knee contractures.

A nurse is reviewing the health record of a 14-year-old child who is suspected of having Hodgkin's disease. Which of the following is the primary characteristic of this disease? 1. Fever and malaise 2. Anorexia and weight loss 3. Painful, enlarged inguinal lymph nodes 4. Painless, firm, and movable lymph nodes in the cervical area

4. Painless, firm, and movable lymph nodes in the cervical area

A nurse is assisting with data collection from an infant who has been diagnosed with hydrocephalus. If the infant's level of consciousness diminishes, a priority intervention is: 1. Taking the apical pulse 2. Taking the blood pressure 3. Testing the urine for protein 4. Palpating the anterior fontanel

4. Palpating the anterior fontanel Rationale: A full or bulging anterior fontanel indicates an increase in cerebrospinal fluid collection in the cerebral ventricle.

A child suspected of having sickle cell disease (SCD) is seen in a clinic, and laboratory studies are performed. Which laboratory value is likely to be increased in sickle cell disease? 1. Platelet count 2. Hematocrit level 3. Hemoglobin level 4. Reticulocyte count

4. Reticulocyte count

A child has a basilar skull fracture. Which of the following health care provider's prescriptions should the nurse question? 1. Restrict fluid intake. 2. Insert an indwelling urinary catheter. 3. Keep an intravenous (IV) line patent. 4. Suction via the nasotracheal route as needed.

4. Suction via the nasotracheal route as needed. Rationale: Nasotracheal suctioning is contraindicated in a child with a basilar skull fracture. Because of the location of the injury, the suction catheter may be introduced into the brain.

A nurse is providing information to the family of a child about a synthetic cast that has been applied to the child for the treatment of a clubfoot. Which information should the nurse provide to the mother? 1. The synthetic cast takes 24 hours to dry. 2. The synthetic cast is heavier than a plaster cast. 3. The synthetic cast is stronger than a plaster cast. 4. The synthetic cast allows for greater mobility than a plaster cast.

4. The synthetic cast allows for greater mobility than a plaster cast.

The client recently diagnosed with SLE asks the nurse, "What is SLE and how did I get it?" Which statement best explains the scientific rationale for the nurse's response? 1. SLE is thought to occur because the kidneys do not filter antibodies from the blood. 2. SLE occurs after a viral illness as a result of damage to the endocrine system. 3. There is no known identifiable reason for a client to develop SLE. 4. This is an autoimmune disease that may have a genetic or hormonal component

4. This is an autoimmune disease that may have a genetic or hormonal component

A disorder in which the blood supply to the epiphyses of the bone is disrupted is callled: 1.) muscular dystrophy 2.) cerebral palsy 3.) congenital hip dysplasia 4.) Legg-Calve-Perthes Disease

4.) Legg-Calve-Perthes Disease

The school nurse notes that the child has a rash and suspects that it is caused by erythema infectiosum (fifth disease). The nurse bases this determination on the observation that the rash results in:

A "slapped-face" appearance Rationale: The classic rash of erythema infectiosum or fifth disease is the erythema on the face

A nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse monitors for the most serious complication associated with this type of traction by checking for:

An elevated temperature Rationale: The most serious complication associated with skeletal traction is osteomyelitis, an infection involving the bone.

An adolescent is seen in the emergency department following an athletic injury, and it is suspected that the child sprained an ankle. X-rays are taken, and a fracture has been ruled out. The nurse provides instructions to the adolescent regarding home care for treatment of the sprain and tells the adolescent which of the following?

Apply ice to the injured area for a period of 30 minutes every 4 to 6 hours for the first 24 hours. Rationale: To treat a sprain, the injured area should be wrapped immediately to support the joint and control the swelling. Ice is applied to reduce the swelling and should be applied for no longer than 30 minutes every 4 to 6 hours for the first 24 to 48 hours.

What should be implemented for a child with von Willebrand disease who has a nosebleed?

Apply pressure to the nose for at least 10 minutes.

An infant is seen in a clinic and is diagnosed with unilateral hip dysplasia. Which finding is associated with this condition?

Asymmetry of the gluteal skin folds when the infant is placed prone and the legs are extended against the examining table

Which of the following assessment findings may indicate that a child had a tonic-clonic seizure during the night?

Blood on the pillow

What test provides a definitive diagnosis of aplastic anemia?

Bone marrow aspiration.

What is a late sign of increased ICP in this child?

Bradycardia

The emergency room nurse is caring for an unconscious 6-year-old girl who has had a severe closed-head injury and notes the following changes in her vital signs. Her heart rate has dropped from 120 to 55, her blood pressure has increased from 110/44 to 195/62, and her respirations are becoming more irregular. After calling the physician, which of the following should the nurse expect to do?

Call for additional help, and prepare to administer mannitol. Rational: Cushing triad is characterized by a decrease in heart rate, an increase in blood pressure, and changes in respirations. The triad is associated with severely increased ICP. Mannitol is an osmotic diuretic that helps decrease the increased ICP.

A nurse is preparing to perform a neurovascular check for tissue perfusion in the child with an arm cast. Which of the following is the priority when performing this procedure?

Checking the peripheral pulse in the affected arm

What kind of diet should be implemented for a child with CF?

Children with CF are managed with a high-calorie, high-protein diet

What are the s/s of the 1st stage of fifth disease (erythema Infectiosum)?

Erythema on the face that gives a slapped face appearance lasting 1-4 days.

What are the s/s of the prodromal stage of Measles (Rubeola)?

Fever, malaise, Coryza (head cold), cough, conjunctivitis, photophobia. Koplik spots - white spots circumscribed in red found on the inside of the cheeks.

When teaching parents about fifth disease (erythema infectiosum) and its transmission, the nurse should provide which information?

Fifth disease is transmitted by respiratory secretions.

What are the late and early signs of ICP in a 5 year old?

Late signs of increased ICP include a significant decrease in the level of consciousness, bradycardia, and fixed and dilated pupils. Nausea is an early sign of increased ICP.

The primary goal to be included in the plan of care for a child who has cerebral palsy is to:

Maximize the child's assets and minimize the limitations.

Nurse Mariane is caring for an infant with spina bifida. Which technique is most important in recognizing possible hydrocephalus?

Measuring head circumference

A child is sent to the school nurse because, according to his teacher, he's constantly scratching his head. When the nurse checks his hair and scalp, she finds evidence of lice. What does the nurse see?

Small white spots that adhere to the hair shaft, close to the scalp

Signs and symptoms of Iron Deficiency Anemia?

Spoon fingers Fatigue, HA, dyspnea, palpitations, pallor, dizziness dyspnea on exertion, sensitivity to cold, decreased concentration.

The nurse expects which of the following clinical manifestations in a child diagnosed with SCID?

Susceptibility to infection.

What are the s/s of the 2nd stage of fifth disease (erythema Infectiosum)?

Symmetrical, lacy maculopapular rash on trunk and limbs for 1 week.

The nurse is teaching parents how to reduce the spread of impetigo. The nurse should encourage parents to:

Teach children the importance of proper hand washing.

A nurse is providing instructions to the parents of a child with scoliosis regarding the use of a brace. Which statement by a parent indicates the need for further instruction?

"I will apply lotion under the brace to prevent skin breakdown."

"When determining the effectiveness of teaching a child's mother about sickle cell disease, which of the following statements by the mother indicates the need for additional teaching? "

"He's going to be playing on a soccer team when he's feeling better." RATIONALE: Physical and emotional stress can precipitate a sickle cell crisis. Physical exercise such as running involved in soccer would increase the child's risk for a crisis.

The nurse is caring for a 2-year-old male in the PICU with a head injury. The child is comatose and unresponsive at this time. The parents ask if he needs pain medication. Select the nurse's best response.

"Pain medication is necessary to promote comfort." Rational: Pain medication promotes comfort and ultimately decreases ICP.

The nurse is caring for a 9-year-old female who is unconscious in the PICU. The child's mother has been calling her name repeatedly and gently shaking her shoulders in an attempt to wake her up. The nurse notes that the child is flexing her arms and wrists while bringing her arms closer to the midline of her body. The child's mother asks, "What is going on?" Select the nurse's best response.

"Your child is demonstrating a reflex that indicates she is overwhelmed with the stimulation she is receiving. Rational: Posturing is a reflex that often indicates that the child is receiving too much stimulation.

The nurse is teaching family members of a child newly diagnosed with muscular dystrophy about early signs. The nurse knows that teaching was successful when a parent states that which of the following signs may indicate the condition early? 1. Increased muscle strength. 2. Difficulty climbing stairs. 3. High fevers and tiredness. 4. Respiratory infections and obesity.

2. Difficulty climbing stairs.

The nurse is performing an admission assessment on a 9-year-old who has just been diagnosed with systemic lupus erythematosus. Which assessment findings should the nurse expect? 1. Headaches and nausea. 2. Fever, malaise, and weight loss. 3. A papular rash covering the trunk and face. 4. Abdominal pain and dysuria.

2. Fever, malaise, and weight loss.

The nurse knows that teaching has been successful when the parent of a child with muscle weakness states that the diagnostic test for muscular dystrophy is which of the following? 1. Electromyelogram. 2. Nerve conduction velocity. 3. Muscle biopsy. 4. Creatine kinase level.

3. Muscle biopsy confirms the type of myopathy that the patient has.

The nurse is caring for a newborn with a myelomeningocele who will have a surgical repair tomorrow. The nurse should do which of the following? 1. Offer formula every 3 hours. 2. Turn the infant back to front every 2 hours. 3. Place a wet dressing on the sac. 4. Provide pain medication every 4 hours.

3. Place a wet dressing on the sac.

The nurse is teaching the parents of a child with Duchenne (pseudohypertrophic) muscular dystrophy. The nurse should tell them that some of the progressive complications include which of the following? 1. Dry skin and hair, hirsutism, protruding tongue, and mental retardation. 2. Anorexia, gingival hyperplasia, and dry skin and hair. 3. Contractures, obesity, and pulmonary infections. 4. Trembling, frequent loss of consciousness, and slurred speech.

3. The major complications of muscular dystrophy include contractures, disuse atrophy, infections, obesity, respiratory complications, and cardiopulmonary problems.

A child with GBS is admitted to the pediatric unit. The child has had lots of oral fluids but has not urinated for 8 hours. The nurse's first action would be to do which of the following? 1. Check the child's serum blood-urea-nitrogen level. 2. Check the child's complete blood count. 3. Catheterize the child in and out. 4. Run water in the bathroom to stimulate urination

3. The child must be catheterized in and out to avoid the possibility of developing a urinary tract infection from urine in the bladder for too long.

The nurse is planning care for a child who was recently admitted with GBS. Which of the following is a priority nursing diagnosis? 1. Risk for constipation related to immobility. 2. Chronic sorrow related to presence of chronic disability. 3. Impaired skin integrity related to infectious disease process. 4. Activity intolerance related to ineffective cardiac muscle function

3. The goal is to prevent complications related to immobility. Efforts include maintaining skin integrity, maintain respiratory function, and preventing contractures.

A child presents with a history of having had an upper respiratory tract infection 2 weeks ago; complains of symmetrical lower extremity weakness, back pain, and muscle tenderness; and has absent deep tendon reflexes in the lower extremities. Which of the following is true regarding this condition? 1. The disease process is probably bacterial. 2. The recent upper respiratory infection is not important information. 3. This may be an acute inflammatory demyelinating neuropathy. 4. CN involvement is rare.

3. This child probably has GBS, which is an acute inflammatory demyelinating neuropathy.

Following surgical repair and closure of a myelomeningocele shortly after birth, which of the following is true of an infant? 1. The infant will not need any long-term management and should be considered cured. 2. The infant will no longer be at risk of urinary tract infections or movement problems. 3. The infant will have continual drainage of cerebrospinal fluid, needing frequent dressing changes. 4. The infant will need lifelong management of urinary, orthopedic, and neurological problems

4. Although immediate surgical repair decreases infection, morbidity, and mortality rates, these children will require lifelong management of neurological, orthopedic, and elimination problems.

The nurse knows that teaching of parents of a child newly diagnosed with CP is successful when the parents state that CP is which of the following? 1. Inability to speak and drooling. 2. Poor dentition due to poor hygiene. 3. Involuntary movements of upper extremities only. 4. An increase in muscle tone and deep tendon reflexes

4. An increase in muscle tone and deep tendon reflexes

The nurse is discussing nutrition with the parents of a child with Duchenne muscular dystrophy. The nurse tells the parents that which of the following foods would be best for their child? 1. High-carbohydrate, high-protein foods. 2. No special food combinations. 3. Extra protein to help strengthen muscles. 4. Low-calorie foods to prevent weight gain.

4. As the child becomes less ambulatory, moving the child will become more of a problem. It is not good for the child to become overweight for several health reasons in addition to decreased ambulation.

The parent of an infant asks the nurse what to watch for to determine if the infant has CP. The nurse should reply which of the following? 1. If the infant cannot sit up without support before 8 months. 2. If the infant demonstrates tongue thrust before 4 months. 3. If the infant has poor head control after 2 months. 4. If the infant has clenched fists after 3 months.

4. If the infant has clenched fists after 3 months.

The physician prescribes corticosteroids for a child with systemic lupus erythematosus (SLE). The nurse knows that the purpose of corticosteroid therapy for this child is to:

Combat inflammation.

The nurse is working in the PICU caring for an infant who has just returned from having a ventriculoperitoneal shunt placed. Which position initially will be most beneficial for this child?

Flat in the crib is the position usually used initially, with the angle gradually increasing as the child tolerates.

The clinic nurse reviews the record of an infant and notes that the health care provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse reviews the assessment findings documented in the record, knowing that which symptom most likely led the mother to seek health care for the infant?

Foul-smelling ribbon-like stools

The nurse is caring for a 6-month-old infant with a diagnosis of hydrocephalus. What sign best indicates increased ICP in this child?

High-pitched cry.

Several children in a kindergarten class have been treated for pinworm. To prevent the spread of pinworm, the school nurse meets with the parents and explains that they should:

Tell the children not to bite their fingernails.

A licensed practical nurse is providing care for a child with hydrocephalus who has had a ventriculoperitoneal shunt revision. Which data collection finding should be reported to the registered nurse immediately?

Temperature 100.9° F

A 6-month-old infant male has just been diagnosed with craniosynostosis. He is being evaluated for reconstructive surgery. The infant's father asks the nurse for more information about the surgery. How should the nurse respond?

The surgery is done to reconstruct the skull to allow the brain to grow properly. Because there are potential complications associated with this surgery, such as increased ICP, the child is usually closely observed in the PICU.

The nurse is preparing to give preoperative teaching to the parents of an infant with hydrocephalus. The nurse knows that the most common treatment for hydrocephalus includes the surgical placement of a shunt connecting which of the following?

The ventricle of the brain to the peritoneum. Rational: The ventriculoperitoneal is the most common shunt used to treat hydrocephalus.

The nurse is caring for a child with sickle cell disease who is scheduled to have a splenectomy. What information should the nurse explain to the parents regarding the reason for a splenectomy?

To prevent splenic sequestration.

The school nurse is examining a student at an elementary school. Which findings would support the diagnosis of impetigo?

Vesicular lesions that ooze, forming crusts on the face and extremities

1. Which is described as the time interval between infection or exposure to disease and appearance of initial symptoms? a. Incubation period b. Prodromal period c. Desquamation period d. Period of communicability

a. Incubation period

Which of the following factors will decrease iron absorption and therefore should not be given at the same time as an iron supplement? a.Milk b.Fruit juice c.Multivitamin d.Meat, fish, poultry

a.Milk

Which is a common childhood communicable disease that may cause severe defects in the fetus when it occurs in its congenital form? a. Erythema infectiosum b. Roseola c. Rubeola d. Rubella

d. Rubella

in what gender is DDH more common?

female

what motion is commonly limited in infants with DDH?

hip ABD

this is avascular necrosis of the femoral head; interruption of blood supply to femoral head results in collapse, fragmentation of hip joint

legg-calves-perthes disease